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HC�� <br />C <br />p�5 <br />G H <br />>HU� <br />4 x9 <br />yxN <br />K (� <br />H �1 <br />oxo <br />'i1 H 'i1 <br />VJ H <br />x <br />��d <br />OH <br />��8 <br />�y] V (i <br />9H� <br />4 <br />t HH <br />y <br />OtyN <br />��[r�1 <br />zy�n <br />H O (n <br />�. <br />__ <br />Date�(�./91. <br />Applicatian For <br />PlJBLIC WORKS PERMIT <br />Prinl or Type Only <br />PueLc worAs Peim�i • _ <br />ema oeot • _�i_1f26559 _ _ _ <br />v„m�c�warwa rec <br />t tai ree S <br />LefsAp01 fee Pa��t $ <br />e.r.,��� o�, S <br />.Teff Parker 5029 W. View Dr. Everett 98203 252-A241 <br />Omne� 1.lailin9 AAdmss City Zip Phane <br />Owner <br />Applicant <br />h�admp Atldiess City Zip Phonc <br />Describe Proposetl Work �dIDll}L mom atiditio11�49_�R <br />Prol�=�� �dtl�ess Uf knovrn) <br />Atl,icn bur �.q copies ol plans lor proUosed work � Draw lo scale and nole Ihe loliowiny as applic�Ule�. <br />• '�operry Lines • Centerlme ol sirect <br />• 7utline and dimensions ol al1 e.c:tmq ;icd • Indicate Naith <br />�ronosed struawes on th�, li,i • Show any proposetl 9radm9 chunqos <br />• ExiS��ncJ anA prOPoSeA ulilibes • Show mca5urements <br />WRITE B[LOW TNIS LINE <br />PERI,11T CONDITIONS <br />L FII calls lor inspection shall be made 24 hrs. in advance � phone 259•8b10. <br />2. All work shall be pedoi tl in accordance wilh this permit and wrrenl City of Evrreu Design and Construction <br />Standards and Specificat�ons. <br />3. Call Location Underground S�rvice 48 hrs. belore you dic�. TOLL FREE NUMBER 1•800•424•5555. <br />�l�'� GC%"' h- ��2ru.T /v0� /�c'p-Letn�-c� <br />0 <br />�� .���y� <br />Approved �or Construction Date <br />FlNAL INSPECTION Date <br />Approvetl as Const�ucted <br />iy�yp�� PUBLICWORKSDEPARTMENT <br />� 320D CeOar Slreet <br />EveretL WA 98201 <br />Phonr '�59-tl910 <br />��CKNOVJLEDG[h5LN7 O� G�NDI710NS <br />� <br />O <br />a <br />The undmsi9ned owneUapphcnnt hereby a9ree, lu hold nnd save harm- <br />less ihe City of Evereit Irom any and all claims for dama9es, cosls. <br />expenses. or causes ol action ihal m� y arise because of inslallahon <br />and mainlenanc� of (he improvement or olher ngh�-oi�way usc herelo <br />applied Ini and fwihor .�grCCs �o remo�c same uP,��� ����ho, hom iho <br />QIIY nnd to ioPCice PuhLc pioPeit�� damayed Iheieby <br />Su�n.�tuie ol Applicanl <br />WORK AUTHpNIZED �Y TIIIS P[RA71T �1UST �[ STr1f7iED WITIIIN <br />1B0 DAYS OF DA7E PERMIT IS ISSUED AND THEREAF1Efi IS i0 <br />DE DILIGEN7LV PURSUED TO COMpL[TION. THIS PERMIT h1AY L3E <br />CANCELLED �Y THE CITV UPON ANY STOPPA6[ OP WOHK ON 11115 <br />PPOJECT OVFR 90 DA': S DUf7ATION <br />